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Junior doctors career trends survey

There has been much debate about the motivations of current doctors in training and suggestions that they are making different choices to their predecessors. This includes a trend to take a break from their clinical training, train less than full time (LTFT) and their attitudes towards an NHS career.

For breaks in training especially, not enough is known about the motivations of doctors who interrupt their training, where they go, what they choose to do or how they perceive their careers to be affected.

In Autumn 2017, the BMA carried out a major UK-wide survey of doctors in training to better understand these issues which have relevance to contemporary medical careers and workforce planning.

Full survey report

The key survey findings

Uncertainty over choice of career specialty and concerns about personal health and wellbeing are major drivers of breaks in training.

Doctors expressed satisfaction at their decision to interrupt training, especially those who felt they needed to step off the 'treadmill' of working day to day in a stressful NHS and decide on their future medical career.

Breaks in clinical training are most common among females, supporting findings from the BMA's recent Cohort Study.

Male and female reasons for a break are different: males are more likely to take a deanery approved out of programme break (OOP), to work in a non-training post either in the UK or overseas, work as a locum or travel; females were more likely to take a break for maternity leave, whereas only tiny numbers of males had done so for paternity.

Three-quarters of doctors who worked overseas on a break chose Australia or New Zealand as their destination.

Less than full time (LTFT) training is mostly pursued by females and those caring for dependents but there is a smaller group without caring responsibilities for whom maintaining their LTFT status is important.

Overall, LTFT trainees report being more satisfied with their training than FTE trainees. Concerningly however, the majority of LTFT trainees see their decision to work as such as being seen negatively by those responsible for their training.

Enthusiasm for working in the NHS is subdued, though highest among females and LTFT doctors and lowest in males and emergency medicine trainees.

Current doctors in training are making decisions about their future career shaped by a desire for autonomy over their work-life balance and independence.

These decisions are sensitive to pressures on the healthcare system, with workload and staffing levels major factors in choice of specialty, and this survey suggests general practice is becoming especially unattractive.

These findings have significance for flexibility of training and qualified NHS posts, medical workforce planning and future gender pay issues.

Comments from the BMA junior doctors committee

"Each year, more junior doctors are opting for a break from their clinical training, and this research offers unparalleled insight into why they are making these decisions and what they are doing with their time out.

"With many saying they needed more time to decide on their career speciality after completing their foundation years, we must work with education providers to look at the underlying reasons for junior doctors wanting to take a step back before committing to a certain career path.

"It is concerning that a significant number of junior doctors said they took a break for health and wellbeing reasons, while anecdotally describing heightened pressures and low morale during their training. The NHS is in the midst of a recruitment and retention crisis, so the government must urgently work with the BMA, healthcare leaders and educators, to address these issues, which are namely to do with workload, stress and burnout.

"While data suggests that the majority of those who opt for a break in training return, and so are not lost to the NHS forever, our research shows they can find the process of re-entering training frustrating. It is therefore vital employers provide the necessary support to ensure a seamless return to work. The commitments laid out by HEE in last year's Supported Return to Training project are a step in the right direction.

Further, with work-life balance and the ability to take future breaks key factors in career decisions, it is evident that workforce planning must take into account this need for greater flexibility to make medicine an attractive prospect."

Further resources

For more information on the career preferences of junior doctors, see the findings from the BMA Cohort Study.

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